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MNsure won't meet goals, study says; revamp on table

ST. PAUL -- While limping along in the short run with its current troubled website, MNsure must quickly pick a strategy for making long-term software fixes and get beyond the recent "crisis mode" that has dominated program management, according to a consultant's report released Wednesday.

Some improvements to the current website can be made in the coming weeks, and MNsure can help consumers by doubling the number of people handling phone calls from consumers, according to a report from Optum, a unit of Minnetonka-based UnitedHealth Group.

The company recommended adding the equivalent of 100 full-time workers and using an Optum call center in Orlando, Fla.

But manual workarounds still will be needed to connect many consumers with coverage this year, according to the report.

In the long run, the report offers three options for the state: pick one of two strategies to remediate the current website, or make more fundamental changes that could involve hiring new software vendors. The report mentions more than 200 defects found with MNsure's current software.

"Zero defects is not a realistic target," said Jim Eppel, a senior vice president at Optum, in comments to MNsure's board of directors during a meeting in St. Paul. "It is a series of trade-offs."

Optum was brought in this month by MNsure to consult on software troubles that have aggravated consumers trying to use the state's new health insurance marketplace. Minnesota launched the MNsure website to implement the federal Affordable Care Act, which requires almost all Americans this year to have health insurance or pay a tax penalty.

The company has been lauded by federal officials for helping improve the HealthCare.gov website, which serves as the health insurance exchange for 36 states this winter. Optum dispatched a team of 15 people to review the MNsure website during a two-day visit this month.

"They brought back some really very robust recommendations," said Scott Leitz, the interim chief executive officer at MNsure, in comments following the board meeting.

MNsure will move forward in the coming days with plans to improve the call center, which likely will include outsourcing some functions to a vendor, Leitz said.

During the meeting, board chairman Brian Beutner suggested that Leitz could free up funds for the call center by suspending MNsure's current advertising campaign, which features Paul Bunyan and Babe the Blue Ox. Leitz said he'd already told staff to do so.

Decisions on how to fix the website, based on Optum's recommendations, will come over the next few weeks.

"We do intend to take action on this report," Leitz told board members.

Enrollment increases

People can use the health insurance exchange to purchase commercial health plans, and learn if they qualify for federal tax credits that can discount premium costs. MNsure also tells people whether they qualify for the Medicaid or MinnesotaCare public health insurance programs.

As of Jan. 18, more than 80,000 people had enrolled in public or private health insurance plans through MNsure, according to numbers released Wednesday. That's a jump of 11 percent compared with about 72,000 people enrolled as of Jan. 4.

Starting next year, MNsure must fund its operations by withholding up to 3.5 percent of the value of premiums for commercial policies sold on the health exchange. The current pace of enrollment is falling below targets, which means the health exchange could face a budget deficit starting next year.

Improving the MNsure website, as well as the ability for consumers to get timely help from the MNsure call center, are key to getting more people to buy coverage through the online marketplace.

"In its current state, the existing MNsure system will not support enrollment expectations," the Optum report stated.

"The only option available to complete the 2014 enrollment period through the (first) quarter is to continue utilizing the existing system," the report stated. "Some improvements can be implemented during this time. However, the majority of attention must be focused on interim actions and manual efforts required to meet enrollment targets."

Hundreds of defects

Optum documented more than 200 defects in the MNsure software, including 108 related to software developed by IBM Curam -- one of four primary vendors on the information technology project. Late last year, IBM dispatched dozens of workers to MNsure's headquarters in St. Paul following a lengthy letter from Gov. Mark Dayton detailing more than a dozen problems with the company's software.

Their first two options take different approaches to rework the current website over the next two years. The third and more dramatic suggestion put forth Wednesday by Optum would have the state create completely new software architecture for the MNsure website. Consumers would continue to use the current website, with minimal improvements, during 2014 and 2015; that would let the state launch a "parallel" effort to begin a "green field," or entirely new solution that would be ready for 2016, the report stated.

One downside is that the "asset may need to be written off -- sunk costs," the report stated.

As of Jan. 8, MNsure had paid software vendors $25.4 million to develop the MNsure website. Maximus Inc. has served as general contractor on the project, with a total contract value of $46.2 million. The Optum report noted that "additional resources are required" to implement any of the three options for the MNsure website.

The report recommended a new program management structure for MNsure because the current structure and process is "nonexistent." It added: "Management/leadership/decision making is occurring via crisis mode."

"Based on Optum's initial review, we are able to conclude that, while MNsure will fall short of achieving its original enrollment goals and consumer satisfaction levels, continuous improvements can be made in both the short-term and long-term," the report stated.

At the conclusion of Wednesday's meeting, board chairman Beutner said the option to "re-architect" the MNsure website wouldn't mean the state is completely starting over.

The current website is constructed from various software "modules" for different functions. In developing new software architecture, MNsure might decide to use some of its current software, Beutner said, along with modules from elsewhere, such as the federal government's HealthCare.gov website.

"I view them as another vendor," Beutner said of the federal government. "I don't necessarily want to limit our three choices as a board to the three options that Optum laid out. ... Maybe we're not good at it, and HealthCare.gov is -- maybe there are parts that we can subcontract to them."